Dislocation.—The ease with which the joint-end of a bone is dislocated varies with its form and structure, and with the position in which it happens to be placed when the violence is applied. The relative frequency of fracture of the bone and dislocation of the joint depends on the strength of the bones above and below the joint relatively to the strength of the joint itself. The strength of the various joints in the body is dependent upon either ligament or muscle, or upon the shape of the bones. In the hip, for instance, all three sources of strength are present; therefore, considering the great leverage of the long thigh bone, the hip is rarely dislocated. The shoulder, in order to allow of extensive movement, has no osseus or ligamentous strength; it is, therefore, frequently dislocated. The wrist and ankle are rarely dislocated; as the result of violence at the wrist the radius gives way, at the ankle the fibula, these bones being relatively weaker than the respective joints. The wrist owes its strength to ligaments, the elbow and the ankle to the shape of the bones. The symptoms of a dislocation are distortion and limited movement, with absence of the grating sensation felt in fracture when the broken ends of the bone are rubbed together. The treatment consists in reducing the dislocation, and the sooner this replacement is effected the better—the longer the delay the more difficult it becomes to put things right. After a variable period, depending on the nature of the joint and the age of the person, it may be impossible to replace the bones. The result will be a more or less useless joint. The administration of an anaesthetic, by relaxing the muscles, greatly assists the operation of reduction. The length of time that a joint has to be kept quiet after it has been restored to its normal shape depends on its form, but, as a rule, early movement is advisable. But when by the formation of the bones a joint is weak, as at the outer end of the collar-bone, and at the elbow-end of the radius, prolonged rest for the joint is necessary or dislocation may recur.
Congenital Dislocation at the Hip.—Possibly as a result of faulty position of the subject during intra-uterine life, the head of the thigh-bone leaves, or fails throughout to occupy, its normal situation on the haunch-bone. The defect, which is a very serious one, is probably not discovered until the child begins to walk, when its peculiar rolling gait attracts attention. The want of fixation at the joint permits of the surgeon thrusting up the thigh-bone, or drawing it down in a painless, characteristic manner.
The first thing to be done is to find out by means of the X-rays whether a socket exists into which, under an anaesthetic, the surgeon may fortunately be enabled to lodge the end of the thigh-bone. If this offers no prospect of success, there are three courses open: First, to try under an anaesthetic to manipulate the limb until the head of the thigh-bone rests as nearly as possible in its normal position, and then to endeavour to fix it there by splints, weights and bandaging until a new joint is formed; second, to cut down upon the site of the joint, to scoop out a new socket in the haunch-bone, and thrust the end of the thigh-bone into it, keeping it fixed there as just described; and third, to allow the child to run about as it pleases, merely raising the sole of the foot of the short leg by a thick boot, so as to keep the lower part of the trunk fairly level, lest secondary curvature of the spine ensue. The first and second methods demand many months of careful treatment in bed. The ultimate result of the second is so often disappointing that the surgeon now rarely advises its adoption. But, if under an anaesthetic, as the result of skilful manipulation the head of the thigh-bone can be made to enter a more or less rudimentary socket, the case is worth all the time, care and attention bestowed upon it. Sometimes the results of prolonged treatment are so good that the child eventually is able to walk with scarce a limp. But a vigorous attempt at placing the head of the bone in its proper position should be made in every case.
(E. O.*)
JOINTS, in engineering, may be classed either (a) according to their material, as in stone or brick, wood or metal; or (b) according to their object, to prevent leakage of air, steam or water, or to transmit force, which may be thrust, pull or shear; or (c) according as they are stationary or moving (“working” in technical language). Many joints, like those of ship-plates and boiler-plates, have simultaneously to fulfil both objects mentioned under (b).
All stone joints of any consequence are stationary. It being uneconomical to dress the surfaces of the stones resting on each other smoothly and so as to be accurately flat, a layer of mortar or other cementing material is laid between them. This hardens and serves to transmit the pressure from stone to stone without its being concentrated at the “high places.” If the ingredients of the cement are chosen so that when hard the cement has about the same coefficient of compressibility as the stone or brick, the pressure will be nearly uniformly distributed. The cement also adheres to the surfaces of the stone or brick, and allows a certain amount of tension to be borne by the joint. It likewise prevents the stones from slipping one on the other, i.e. it gives the joint very considerable shearing strength. The composition of the cement is chosen according as it has to “set” in air or water. The joints are made impervious to air or water by “pointing” their outer edges with a superior quality of cement.
Wood joints are also nearly all stationary. They are made partially fluid-tight by “grooving and tenoning,” and by “caulking” with oakum or similar material. If the wood is saturated with water, it swells, the edges of the joints press closer together, and the joints become tighter the greater the water-pressure is which tends to produce leakage. Relatively to its weaker general strength, wood is a better material than iron so far as regards the transmission of a thrust past a joint. So soon as a heavy pressure comes on the joint all the small irregularities of the surfaces in contact are crushed up, and there results an approximately uniform distribution of the pressure over the whole area (i.e. if there be no bending forces), so that no part of the material is unduly stressed. To attain this result the abutting surfaces should be well fitted together, and the bolts binding the pieces together should be arranged so as to ensure that they will not interfere with the timber surfaces coming into this close contact. Owing to its weak shearing strength on sections parallel to the fibre, timber is peculiarly unfitted for tension joints. If the pieces exerting the pull are simply bolted together with wooden or iron bolts, the joint cannot be trusted to transmit any considerable force with safety. The stresses become intensely localized in the immediate neighborhood of the bolts. A tolerably strong timber tension-joint can, however, be made by making the two pieces abut, and connecting them by means of iron plates covering the joint and bolted to the sides of the timbers by bolts passing through the wood. These plates should have their surfaces which lie against the wood ribbed in a direction transverse to the pull. The bolts should fit their holes slackly, and should be well tightened up so as to make the ribs sink into the surface of the timber. There will then be very little localized shearing stress brought upon the interior portions of the wood.
Iron and the other commonly used metals possess in variously high degrees the qualities desirable in substances out of which joints are to be made. The joint ends of metal pieces can easily be fashioned to any advantageous form and size without waste of material. Also these metals offer peculiar facilities for the cutting of their surfaces at a comparatively small cost so smoothly and evenly as to ensure the close contact over their whole areas of surfaces placed against each other. This is of the highest importance, especially in joints designed to transmit force. Wrought iron and mild steel are above all other metals suitable for tension joints where there is not continuous rapid motion. Where such motion occurs, a layer, or, as it is technically termed, a “bush,” of brass is inserted underneath the iron. The joint then possesses the high strength of a wrought-iron one and at the same time the good frictional qualities of a brass surface. Leakage past moving metal joints can be prevented by cutting the surfaces very accurately to fit each other. Steam-engine slide-valves and their seats, and piston “packing-rings” and the cylinders they work to and fro in, may be cited as examples. A subsidiary compressible “packing” is in other situations employed, an instance of which may be seen in the “stuffing boxes” which prevent the escape of steam from steam-engine cylinders through the piston-rod hole in the cylinder cover. Fixed metal joints are made fluid tight—(a) by caulking a riveted joint, i.e. by hammering in the edge of the metal with a square-edged chisel (the tighter the joint requires to be against leakage the closer must be the spacing of the rivets—compare the rivet-spacing in bridge, ship and boiler-plate joints); (b) by the insertion between the surfaces of a layer of one or other of various kinds of cement, the layer being thick or thin according to circumstances; (c) by the insertion of a layer of soft solid substance called “packing” or “insertion.”
Apart from cemented and glued joints, most joints are formed by cutting one or more holes in the ends of the pieces to be joined, and inserting in these holes a corresponding number of pins. The word “pin” is technically restricted to mean a cylindrical pin in a movable joint. The word “bolt” is used when the cylindrical pin is screwed up tight with a nut so as to be immovable. When the pin is not screwed, but is fastened by being beaten down on either end, it is called a “rivet.” The pin is sometimes rectangular in section, and tapered or parallel lengthwise. “Gibs” and “cottars” are examples of the latter. It is very rarely the case that fixed joints have their pins subject to simple compression in the direction of their length, though they are frequently subject to simple tension in that direction. A good example is the joint between a steam cylinder and its cover, where the bolts have to resist the whole thrust of the steam, and at the same time to keep the joint steam-tight.